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The Importance of Direct Resins in Dental Practice

Gerard E. Denehy, DDS, MS

Aesthetic dentistry has
assumed an important role in the contemporary practice as patients increasingly
request treatments that reflect society's emphasis on health and beauty. A
youthful appearance is often directly related to the perception of one's well-being,
and improving the aesthetics of a patient's smile can be beneficial in
establishing this image. Aesthetic dentistry can be utilized to improve a
patient's self-image, and allows the clinician to generate additional income,
experience positive patient feedback, and exercise artistic skills.

Dental
professionals and manufacturers have generally been able to satisfy the demand
for improved aesthetic techniques and products. The range of restorative
materials available to the clinician is expanding daily, and adhesive bonding
procedures have continued to be refined. Direct resins are available in a
variety of shades that range from ultralight to dark opaque, which allows the
treatment of even bleached or geriatric dentition. Innovative materials also
offer various degrees of translucency and opacity that can mimic dentin and
enamel and provide characterization for any anterior tooth. Handling properties
of the composite resins have been improved with low-viscosity flowable systems
and packable materials that simulate the handling characteristics of amalgam.
Sculptable composite resins that easily maintain their shape have also been
developed, which permits the clinician to replicate tooth contours during
material insertion and minimize finishing procedures.

Despite
the availability of excellent direct restorative materials, indirect
laboratory-fabricated porcelain or resin materials are being placed with
increased frequency. Although their use is often justified due to generalized
discoloration, extensive loss of tooth structure, or occlusal considerations,
these restorations are often used indiscriminately to treat aesthetic
situations, and patients are provided no other restorative option. By embracing
indirect restorations for the treatment of the majority of aesthetic
situations, the clinician and the patient will miss several important aspects
of direct restorations. Although a direct restoration may have a more limited
life span than an indirect restoration, this can present certain clinical
advantages. Porcelain longevity is often measured by the appearance and the
durability of the restorations. Since direct resins are weaker than tooth
structure, they have a significantly reduced potential to damage opposing
dentition in comparison to porcelain materials. Composite resins can also be
more easily repaired than porcelain, which can be a benefit in certain
instances.

In
addition, the placement of indirect restorations always requires a degree of
tooth reduction. Although these preparations are conservative by conventional
standards, the defect-specific cavity designs currently utilized with direct
restorations preserve greater tooth structure. Numerous situations (eg,
diastema closure) require no preparation when restored with direct resin
procedures. Although malaligned teeth are often aesthetically straightened with
indirect restorative techniques, this requires large amounts of tooth reduction
to provide proper aesthetics and space for seating of the restoration. Direct
modalities, however, can utilize illusionary techniques to perform realignment
without significant loss of tooth structure.

Unfortunately,
the expense involved in aesthetic dental treatment may preclude patients from
enjoying its benefits, particularly when indirect restorations are utilized.
The increased expense associated with quality laboratory-fabricated
restorations must be reflected in an overall treatment cost that many patients
cannot afford. Although the longevity of a direct restoration may be shorter,
the expense of its replacement is less than that of indirect options over
time.

The
aesthetic options presented to the patient are often relegated to the
clinician's expertise in the procedure involved and the anticipated income
derived from its successful completion. The lack of instruction with aesthetic
direct resin procedures during university training often does not provide the
clinician with the technical skills and confidence necessary to offer a full
range of direct restorative services. Although numerous continuing education
opportunities focus on indirect techniques, quality courses are available for
the aesthetic placement of direct composite restorations as well. The technical
proficiency and knowledge acquired in these courses--along with continuous
monitoring of the professional literature--will benefit the clinician not only
with direct restorations, but also with the entire aesthetic armamentarium.

Case
Presentation

A
76-year-old female patient presented with malaligned dentition and aesthetic
concerns (Figures1 and2). The patient was unwilling to have orthodontic
treatment and unable to afford indirect restorations. The use of direct resin
restorations provided an affordable option for the treatment of the patient
with a reasonable amount of chairtime and conservative reduction of tooth
structure.

Using
a flame diamond bur, the existing restoration on the left maxillary central
incisor was removed, and the facial and proximal contours of the central and
lateral incisors were adjusted to provide space for composite rebuilding (Figures3 and4). The teeth were restored with a combination
of hybrid composite and microfilled resin to establish the desired shape and
contour (Figures5 and6). The definitive restoration provided the
desired aesthetic result and satisfied the objectives of the patient.

Conclusion

As
the aesthetic expectations of the public continue to evolve, it is important
that clinicians utilize restorative techniques and materials that achieve these
objectives in a conservative, durable, yet affordable manner. When properly
used, direct resin materials can provide solutions to numerous aesthetic
challenges while still providing adequate practice revenues. By capitalizing on
the learning opportunities that are currently available, dental students can
develop techniques for the incorporation of these techniques and materials to
the mutual benefit of patient and clinician alike.